17 October 2013

Urgent Care Centers, We Really Need Them

Again, when something is needed, we see the primary care physicians (PCPs) lining up against them and in states with strong medical boards, they are being prevented from coming into existence. I am talking about urgent care centers (UCCs). With the shortage of primary care physicians, the strain on most hospital emergency departments (ED), and rising health care costs, these urgent care centers operate as a great convenience to non-emergency cases.

Since PCPs do not have evening office hours, this only seems reasonable that UCCs can fill a great need in caring for people not needing the services of the ED. In addition, costs are less than the ED. The PCPs are claiming that this is hurting their people and safety is an issue. Some providers believe urgent care centers disrupt coordination and continuity of care. I say to these providers, then have practices that are open 16 hours per day, 7 days a week and there would not be the need for UCCs.

Others believe the concerns of PCPs may be overstated, given urgent care’s focus on episodic and simple conditions rather than chronic and complex cases. In the future, health coverage expansions under the national health reform may lead to greater capacity strains on both primary and emergency care, causing even more growth of urgent care centers. Hospitals view urgent care centers as a way to gain patients, while health plans see opportunities of containing costs by steering patients away from costly emergency department visits.

UCCs are not designed to handle car accidents or resuscitate patients at death's door, but they do treat minor injuries such as cuts and minor fractures, as well as the ear infections and strep throats of primary care. The Urgent Care Association of America puts the number of UCCs at 9000, with physicians or physician groups owning 35% of them. In addition, corporations own 30%, hospitals own 25%, and non-physician individuals or franchisors own 7%.

Rapid expansion of UCCs is often attributed to such factors as long wait times for primary care appointments, crowded emergency departments and patient demand for more accessible care, including after-hours appointments. UCCs provide care on a walk-in basis, typically during regular business hours, as well as evenings and weekends, though not 24 hours a day. UCCs commonly treat conditions seen in primary care practices and retail clinics, including ear infections, strep throat and the flu, as well some minor injuries, such as lacerations and simple fractures.

UCCs generally are not equipped to deal with trauma, provide resuscitation or admit patients to a hospital, all reasons for seeking ED care. UCCs are typically staffed by physicians, generally with backgrounds in primary care or emergency medicine, and some have nurse practitioners or physician assistants working under physician supervision.

Patient demand for more convenient access to care reportedly has increased, prompting renewed growth in urgent care centers. According to a recent study, approximately 60 percent of patients with a usual primary care physician (PCP) reported that their PCP practices do not offer extended hours, suggesting a niche for urgent care centers to fill.

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